Objective To provide evidence for timely diagnosis and treatment of Kawasaki disease through assessing the relationship between the duration of fever and the incidence of coronary artery lesion in patients with Kawasaki disease. Methods To retrospectively analyze the clinical information of 352 inpatients with Kawasaki disease (including typical Kawasaki disease, incomplete Kawasaki disease, and non-responsive to intravenous immunoglobulin treatment Kawasaki disease ) from January 1997 to December 2007. The relationship between the duration of fever and the incidence of coronary artery lesion was presented by a linear trend plot, using Cochran-Armitage trend test. A value of P lt; 0.05 was considered statistically significant. Results Among 352 patients with Kawasaki disease, 88 had coronary artery lesions. Sixty-eight out of 294 patients with typical Kawasaki disease, 20 out of 58 patients with incomplete Kawasaki disease, and 18 out of 44 patients with non-responsive Kawasaki disease had coronary artery lesions. Linear trend analysis showed that the duration of fever in all 352 patients with Kawasaki disease and 294 cases with typical Kawasaki disease was positively correlated with the incidence of coronary artery lesion (Plt;0.05). However, in patients with incomplete Kawasaki disease and non-responsive Kawasaki disease, the relationship between the duration of fever and the incidence of coronary artery lesion was not significant (Pgt; 0.05). Conclusion The longer the duration of fever was in patients with Kawasaki disease, higher the risk of coronary artery lesion.
Objective To explore clinical application and significance of coronary angiography （CAG） prior to heart valve replacement for patients with rheumatic valvular heart disease （RVHD）. Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results，313 patients were divided into two groups. In the coronary artery lesion （CAL） group，there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion （non-CAL）group，there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL，and the overall prevalence of CAL was 9.27%. In CAL group，11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient （3.45%） died of low cardiac output syndrome （LCOS）. In non-CAL group，5 patients （1.76%） postoperatively died mainly because of LCOS，ventricular fibrillation，sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group （P＜0.05）. There was no statistical difference in postoperative mortality，incidence of LCOS，acute renal failure，respiratory failure，reexploration for bleeding，intraoperative blood loss，mechanical ventilation time or hospital stay between the two groups（P＞0.05）. There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years （OR=5.534，P=0.005），male gender （OR=2.335，P=0.038） and diabetes mellitus （OR=4.265，P=0.006） were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL （age≥55 years，male gender and diabetes mellitus），CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.